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Z-score is a possible predictor of the risk of coronary artery lesion development in patients with Kawasaki disease in Japan

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Abstract

Risk factors for coronary artery lesion (CAL) development in patients with Kawasaki disease (KD) include male sex, age < 12 months, intravenous immunoglobulin (IVIG) resistance, and delayed diagnosis.. We aimed to explore the relationship between CAL development and Z-score. We enrolled 281 patients with KD who were treated with our protocol. Echocardiography was performed in three phases: pre-treatment (P1), post-treatment (P2), and 4 weeks after onset (P3). The highest Z-score of the right, left main, left anterior descending, and left circumflex coronary arteries was expressed as Zmax at each phase. P3-Zmax ≥ 2.5 represented CAL development. Clinical parameters, such as laboratory data and Z-scores, were retrospectively compared between patients with and without CAL development. Sixty-seven patients (23.8%) showed a P1-Zmax ≥ 2.0, and CAL development occurred in 21 patients (7.5%). Independent risk factors associated with CAL development were P1-Zmax, a ΔZmax (P2-Zmax − P1-Zmax) ≥ 1, male sex, < 12 months of age, and resistant to the first intravenous immunoglobulin (IVIG) administration (adjusted odds ratio [95% confidence interval]: 198 [1.01–3.92], 4.04 [1.11–14.7], 6.62 [1.33–33.04], 4.71 [1.51–14.68], 5.26 [1.62–17.13], respectively). Using receiver operating characteristic curve analysis, a P1-Zmax ≥ 1.43 detected CAL development with an area under the curve of 0.64 (sensitivity = 81.0%; specificity = 48.1%).

Conclusion: Our results suggest that P1-Zmax and a ΔZmax (P2-Zmax − P1-Zmax) ≥ 1 may predict CAL development.

What is Known:

• KD is an acute vasculitis predominantly affecting the coronary artery of young children.

• Although P1 Z-max ≥ 2.0 has been a predictor of CAL development, it has not yet been shown in Japan.

What is New:

• P1-Zmax and a ΔZmax ≥ 1 are presumably associated with CAL development.

• In the ROC curve analysis, P1-Zmax ≥ 1.43 detected CAL development, a sensitivity (81%) and a specificity (48%). We need to consider intensified initial therapy for patients with these risk factors.

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Data availability

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Code availability

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Abbreviations

CAL:

Coronary artery lesion

CsA:

Cyclosporin A

IVIG:

Intravenous immunoglobulin

KD:

Kawasaki disease

LAD:

Left anterior descending artery

LCX:

Left circumflex artery

LMCA:

Left main coronary artery

P1:

Pre-treatment phase (at the time of KD diagnosis or before IVIG treatment)

P2:

Post-treatment phase (after first IVIG treatment and around 10 days from KD onset)

P3:

The convalescent phase (around 4 weeks from KD onset)

RCA:

Right coronary artery

Zmax:

The highest Z-score of four segments of coronary artery

ΔZmax:

Difference between P2-Zmax and P1-Zmax

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Funding

This work was supported by Grants-in-Aid for Scientific Research (KAKENHI 20K08189) from the Ministry of Education, Culture, Sports, Science and Technology (MEXT).

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Authors and Affiliations

  1. Department of Pediatrics, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-0012, Japan

    Takayuki Suzuki, Nobuyuki Kakimoto, Tomoya Tsuchihashi, Tomohiro Suenaga, Takashi Takeuchi & Hiroyuki Suzuki

  2. Department of Pediatrics, Kinan Hospital, Tanabe, Japan

    Shoichi Shibuta

  3. Research Center for Community Medicine, Wakayama Medical University, Wakayama, Japan

    Naomi Kitano

  4. Department of Public Health, Wakayama Medical University School of Medicine, Wakayama, Japan

    Naomi Kitano

Authors
  1. Takayuki Suzuki
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  2. Nobuyuki Kakimoto
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  3. Tomoya Tsuchihashi
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  4. Tomohiro Suenaga
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  5. Takashi Takeuchi
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  7. Naomi Kitano
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  8. Hiroyuki Suzuki
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Contributions

Takayuki Suzuki collected data, designed the study, and drafted initial analyses and manuscript. Nobuyuki Kakimoto, Tomohiro Suenaga, and Takashi Takeuchi were responsible for echocardiography examination and data collecting. Tomoya Tsuchihashi, Shoichi Shibuta, Naomi Kitano, and Hiroyuki Suzuki contributed to the study design and data analysis and revised the manuscript. All authors read and approved the final manuscript

Corresponding author

Correspondence to Hiroyuki Suzuki.

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This study was approved by the ethics committee of Wakayama Medical University (No: 2801).

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Informed consent was waived, because all data were de-identified.

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The authors declare no competing interests.

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Communicated by Peter de Winter

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Suzuki, T., Kakimoto, N., Tsuchihashi, T. et al. Z-score is a possible predictor of the risk of coronary artery lesion development in patients with Kawasaki disease in Japan. Eur J Pediatr 180, 2797–2805 (2021). https://doi.org/10.1007/s00431-021-04006-1

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  • DOI: https://doi.org/10.1007/s00431-021-04006-1

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